Primary Nursing Diagnosis

Pain (chronic) related to joint swelling and deformity

OUTCOMES. Comfort level; Pain control behavior; Pain: Disruptive effects; Pain level

INTERVENTIONS. Pain management; analgesic administration; Positioning; Teaching: Prescribed activity/exercise; Teaching: Procedure/treatment; Teaching: Prescribed medication

U PLANNING AND IMPLEMENTATION Collaboration

The goals of treatment are to relieve pain, inhibit the inflammatory response, preserve joint function, and prevent deformity. Initial medical treatment consists of pharmacologic measures. An appropriate ongoing exercise program is prescribed by the physical therapist; this includes teaching proper body mechanics. Therapy may also include the use of moist heat, but ice may be prescribed in some cases. Splints are provided for painful joints. The physical therapist teaches the patient to use a walker and cane if indicated.

Some patients may undergo surgery to restore joint function. One type of procedure, a synovectomy, involves removal of the inflamed synovium early in the disease process. Patients who are in relatively good physical and mental condition may be candidates for joint reconstructive surgery (arthroplasty). The effectiveness of hip and joint replacement is considered quite good, although replacement surgery associated with other joints is less efficacious. Osteotomy involves cutting the bone to realign the joint and to shift the pressure points to a less denuded area of the joint; this shift relieves pain. Tendon transfers may prevent deformities or relieve contractures.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Nonsteroidal

Varies with drug

Aspirin, ¬°buprofen, plroxicam,

Relieve pain; may be given

anti-inflammatory

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